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Psychodynamic Psychotherapy: A Clinical Manual Second Edition
Abstract
The prelims comprise: Half-Title Page Title Page Copyright Page Dedication Contents Preface Acknowledgments Use of This Manual About the Companion Website Introduction
... The defense mechanism is a mental process that helps a person find compromise solutions for conflict resolution (Freud, 1962). The ego uses defensive mechanisms to reduce the pain caused by emotions, thoughts, and dreams, which are often unconsciously effective (Cabaniss et al., 2016). The defense mechanisms work as a protective shield against outward dangers which generates security in the person and segregates oneself from perceived external threats (Gabbard, 2017) proposed a three-level classification of defense mechanisms: (1) primitive defenses or immature (i.e., regression, acting out, splitting, projection, projective identification, denial, idealization, dissociation, schizoid fantasy, and somatization); (2) higher-level (neurotic) defenses (i.e., displacement, introjection, intellectualization, identification, isolation, sexualization, rationalization, reaction formation, undoing, and repression); and (3) mature defenses (i.e., altruism, humor, sublimation, asceticism, suppression, and anticipation). ...
... Findings from the first hypothesis indicated that defense mechanisms had a significant direct effect on alexithymia. This finding is congruent with theoretical perspectives on defense mechanisms (Baily & Pico, 2022;Cabaniss et al., 2016;Freud, 1962;Gabbard, 2017), alexithymia (Dincer et al., 2021;Falahati & Mohammadi, 2020;Lumley et al., 2007;Sifneos, 1973Sifneos, , 2000Zanganeh Motlag et al., 2017), and the earlier studies about the interconnection between these constructs (American Psychiatric Association, 2013; Baily & Pico, 2022;Cramer, 1991;Gabbard, 2017;Kreitler & Kreitler, 2004;Lenzo et al., 2020). This study suggests that when females encounter anxiety or threat-provoking events, due to their previous developmental experiences the ego motivates them to use different defensive mechanisms for coping against internal or external threats. ...
... The results showed that immature and neurotic defense mechanisms had a positive and significant path coefficient with marital conflict and sexual dysfunctions, while a significant negative path coefficient was found between the mature defense mechanisms as observed variables in SEM calculation with dependent variables. These results conform to the predictions of conceptualizations in defense mechanisms (Cabaniss et al., 2016;Freud, 1962;Gabbard, 2017). Also, these findings are compatible with the literature that demonstrated mature, immature, and neurotic defense mechanisms are linked to different aspects of marital conflict (Farazi et al., 2021;Levite & Cohen, 2012;Nasershariati, 2022;Pirsaghi et al., 2015;Sivandian & Besharat, 2019;Soldz & Vaillant, 1998;Stevenson & Hiebert, 2021) and sexual dysfunctions (Brody & Costa, 2008;Brody et al., 2010;Brody & Nicholson, 2013;Costa et al., 2019;Erdogan et al., 2022;Gouvernet et al., 2020). ...
This study examined the influence of defense mechanisms and alexithymia on marital conflict and sexual dysfunction using structural equation modeling (SEM) in women. A clinical sample of 342 participants was selected using a purposive sampling as part of a descriptive design. The data was collected using the Defense Style Questionnaire (DSQ-40), the Toronto Alexithymia Scale-20 (FTAS-20, the Kansas Marital Conflict Scale (KMCS), and the Female Sexual Function Index (FSFI). The analysis found that defense mechanisms had a significantly direct influence on alexithymia, and defense mechanisms and alexithymia have significantly direct impacts on marital conflict and sexual dysfunctions. Defense mechanisms with the mediator role of alexithymia explained 72.6% of marital conflict and 75.5% of sexual dysfunction variations in females. Also, marital conflict indicated a significant positive relationship with sexual dysfunctions in married females. This study has shown a fitted SEM for the direct and indirect effects of defense mechanisms on marital conflicts and sexual dysfunctions concerning the mediator role of alexithymia in females. These results have practical implications for psychotherapeutic intervention and community-based programs among females affected by marital conflict.
... Psychodynamic approaches were based on the understanding that people are motivated by experiences, thoughts, memories, and feelings that are outside of their awareness. In expressive approaches the therapist emphasizes uncovering the unconscious aspects of life that have adversely impacted mood, behavior, and relationships (Cabaniss et al., 2011). Importance is given to analyzing and interpreting psychological defenses, motives for those defenses, underlying drives, and the transference. ...
... Complete anonymity, even if possible, is not always advisable. Patients with weaker ego function are vulnerable to feeling anxious, demeaned, or mistrustful of therapists who are silent or opaque (Cabaniss et al., 2011). Abstinence means not gratifying the patient's unconscious wishes of the therapist. ...
... The therapist may function as an observing ego helping the patient learn to step back and honestly critique their thoughts, feelings, and behaviors. Encouraging the patient to feel safe enough to disclose personal details might require the therapist to become more active, personal, conversational, and responsive (Cabaniss et al., 2011;Holmes, 1995;Misch, 2000). ...
Supportive psychotherapy interventions were developed as a part of psychodynamic psychotherapy work, and supportive psychotherapy was historically considered to be the default form of therapy only for lower-functioning patients. These roots unfortunately have resulted in supportive psychotherapy being viewed as an inferior form of treatment. In reality, supportive psychotherapy is a practical and flexible form of psychotherapy that helps patients with a wide range of psychiatric illnesses, including mood disorders, anxiety disorders, posttraumatic stress disorder, schizophrenia, personality disorders, eating disorders, body dysmorphic disorder, and substance use disorders. In addition, supportive psychotherapy can be well-suited to higher-functioning patients, as well as to patients who are chronically lower-functioning. There is also evidence to support the use of supportive psychotherapy in patients with certain medical illnesses, including coronary artery disease, some gastrointestinal illnesses, HIV infection, and certain types of cancer. The goals of supportive psychotherapy include helping patients to understand emotional experiences, improving affective regulation and reality-testing, making use of their most effective coping strategies, and engaging in collaborative problem solving to reduce stressors and increase effective engagement with support systems.
... Knowledge of unconscious motivation may also threaten personal and professional world views, resulting in anxiety that is then defended against by rejecting or devaluing these concepts. When groups or individual encounter ideas or actual experience that collide with their core unconscious fantasies, they initiate ego defenses that attempt to eliminate or alleviate the negative affects (Arlow, 1969(Arlow, , 2002Cabaniss, 2011b). ...
... A disproportionate emotional response to a stimulus can also suggest that unconscious emotional variables are in play, which may include the intrusion of unconscious fantasies into everyday life (Arlow, 1969;Cabaniss, 2011b;Reed, 2017). Some social work scholars express an extremely negative attitude toward psychoanalytic theory or ideas that seems overly intensea tone that is not present when other theories are discussed. ...
... While such strategies may be helpful, they do not directly address the unconscious fantasies and underlying anxieties in social work education/theory about psychoanalytic theory. According to its principles, making the unconscious conscious is a fundamental psychoanalytic therapeutic process (Cabaniss, 2011b). Psychoanalytic theory recommends that defenses and affect usually should be interpreted prior to content/impulse. ...
Psychoanalytic social work scholars lament the marginalization of psychodynamic theory in contemporary social work academia. Modern conflict theory applied to social work theories of pathogenesis and cure can serve as a means to explore this marginalization. Unconscious fantasy is important for understanding the resistance to psychodynamic theory in social work education. I offer some psychoanalytically informed strategies that might begin to restore psychodynamic theory in mainstream social work academia.
... Didactic teaching is limited in facilitating this kind of development. Educational research has shown that useable knowledge is not effectively transmitted through abstract ideas (Cabaniss et al., 2011). One can, for example, learn about how to ride a bicycle from a book, but no book is sufficient to teach a person to actually ride a bicycle. ...
... Working with parallel process is also, arguably, more effective than engaging in ''role play,'' a technique that invites the supervisee to be the patient while the supervisor plays the role of therapist. Role play is seen in the education literature as superior to didactic methods for teaching complex skills (Cabaniss et al., 2011). When a supervisee unintentionally enacts the problem with the supervisor, through the parallel process, and the supervisor responds helpfully, the supervisee's experience is, arguably, even more meaningful and impactful than during a role play because it occurs in a spontaneous and authentic transaction. ...
... In addition, if supervisor and supervisee are able to theorize what has gone on between them, it helps a supervisee to link up abstract conceptualization to lived experience, an essential component of effective psychotherapy training (Binder, 1999;Cabaniss et al., 2011). When a supervisee and I ''unpacked'' what had been going on in a parallel process, identifying projective identifications that we had each been responding to, she commented that she now understood the concept of projective identification ''in her bones.'' ...
The concept of parallel process has played a central role in psychoanalytic supervision for the last 60 years, generating continuing interest in the power of the unconscious to create unexpected intersections between the analytic and supervisory relationships. I track the evolution of the concept, starting with its invention by an interpersonalist psychoanalyst, adoption by two ego psychologists, enrichment by object relations theory, and, finally, redefinition as a multi-directional dynamic by relational psychoanalysts. I then further elaborate the relational view of parallel process, illustrating its complex, multidirectional nature with an extended vignette. I discuss the relationship of enactment to parallel process and illustrate the usefulness of supervisory consultation when enactments that parallel into the supervisory relationship lead to impasse. Finally, I point to educational and neuropsychological research that suggests that working with parallel process is good pedagogy.
... Hidden meanings may also be found in a patient's "off the cuff" remarks or overemphasized assertions (e.g., Cabaniss et al., 2011). ...
... This may be necessary for them to maintain homeostasis. In such a case, a therapist might utilize supportive bypassing, or the direct avoidance of topics that will lead to unhelpful levels of distress during session (e.g., see Cabaniss, Cherry, Douglas, & Schwartz, 2011). At first glance this might appear to be antithetical to psychodynamic therapy, but would in fact be indicated for sicker patients who are already suffering. ...
The phrase “psychodynamic therapy” refers to the family of treatment approaches based on the early work of Sigmund Freud. It is one of the major forms of contemporary psychotherapy practice and has undergone a great deal of theoretical and technical modification over the past 120 years. Its main techniques have been catalogued and many forms of psychodynamic therapy have been manualized. There is mounting evidence not only in favor of its efficacy, but also in terms of theory-based mechanisms of change and the research generativity of its concepts (e.g., attachment theory).
... Hidden meanings may also be found in a patient's "off the cuff" remarks or overemphasized assertions (e.g., Cabaniss et al., 2011). ...
... This may be necessary for them to maintain homeostasis. In such a case, a therapist might utilize supportive bypassing, or the direct avoidance of topics that will lead to unhelpful levels of distress during session (e.g., see Cabaniss, Cherry, Douglas, & Schwartz, 2011). At first glance this might appear to be antithetical to psychodynamic therapy, but would in fact be indicated for sicker patients who are already suffering. ...
The phrase “psychodynamic therapy” refers to the family of treatment approaches based on the early work of Sigmund Freud. It is one of the major forms of contemporary psychotherapy practice and has undergone a great deal of theoretical and technical modification over the past 120 years. Its main techniques have been cataloged and many forms of psychodynamic therapy have been manualized. There is mounting evidence not only in favor of its efficacy, but also in terms of theory-based mechanisms of change and the research generativity of its concepts (e.g., attachment theory).
... Though nightmare distress and frequency significantly related to neuroticism, after controlling for ego strength neuroticism no longer predicted either variable. This supports the notion that the neuroticism is regulated by the ego (Cabaniss et al., 2011), at least with regards to nightmares, and that nightmares and associated distress may persist due to ego dysregulation (Freud, 1900(Freud, , 1920. The current findings also are somewhat consistent with those of Yu (2014) who found no significant correlation with nightmares using an ego strength measure that more closely resembled ego resiliency. ...
... Indeed, ego strength appears to provide some buffer not only of nightmare production but also of waking distress reactions to nightmares. The latter might relate to the reality testing function of the ego (i.e., Cabaniss et al., 2011). ...
The current research investigated ego strength as a construct which could partly explain the associations of nightmares with trait neuroticism and state general psychological distress. In three studies involving 416 university students, ego strength predicted frequent and distressing nightmares independent of neuroticism and general distress. After controlling for ego strength, neuroticism and general distress were no longer significantly related to nightmares. These findings were consistent across different measurement scales and independent samples. It was concluded that nightmares are better explained by the theoretically based ego strength construct than the descriptive constructs of trait neuroticism and general distress. The results and limitations of the studies are discussed in addition to recommendations for future research.
... When interpretations are made, they often involve explaining the problematic situation, the nature of conflicts and the compromise solutions to those conflicts from the standpoint of unconscious wishes or intentions that needed to be repressed for the sake of psychological survival and maintaining attachment relationships (Brenner, 1974). Concepts of unconscious intentions as articulated in such interpretations (Cabaniss, 2016) often cast unconscious thoughts and feelings as being in the same form as their conscious counterparts except that they are excluded from conscious awareness by virtue of defenses such as repression. ...
... As previously noted, a foundational theory that may be the bedrock of psychoanalysis is that forbidden impulses, urges, and wishes are held in abeyance in the unconscious due to defenses (Brenner, 1974;Cabaniss, 2016;McWilliams, 2011). These defenses classically include repression most prominently but also include projection, displacement, reaction formation, isolation of affect, and sublimation, as well as more primitive defenses such as splitting, projective identification, and dissociation. ...
Recurrent maladaptive patterns (RMPs) have been a foundational concept in psychodynamic therapy (PDT) and psychoanalysis for over a century. Typically associated with character pathology (i.e., personality disorders), they highlight the remarkable correspondences frequently observed between relationship patterns in a person’s family of origin, their current adult relationships, and the transference relationship with the therapist. These patterns can be understood as an expression of schemas and therefore share a common conceptual foundation with other major psychotherapy modalities. Yet, the centrality of affect in the origin/development of these maladaptive patterns and their treatment may not be widely appreciated among practitioners of PDT or any other modality. The basic thesis of this chapter is that RMPs as described in the PDT literature could potentially become more widely recognized, understood, and treated in an integrated manner if their developmental and affective origin were more generally appreciated. Doing so would not only improve interpersonal functioning but could also alter the affective dysfunction that predisposes to the development of symptoms that are a common reason for seeking treatment. Consistent with newer developments in psychodynamic theory grounded in observations from early childhood development, this chapter briefly reconsiders the fundamental elements of RMPs, including unconscious processes, development, conflict, defenses, and mechanisms of change from the perspective of affective science and computational neuroscience. In so doing, the goals are to broaden appreciation of the importance and ubiquity of RMPs by explaining them in nonclinical language, to increase the likelihood of enduring change by promoting an integrative approach to their treatment focusing on new emotional experiences in meaningful contexts and to facilitate research that can potentially establish the benefits of such an approach.
... Dr. Cabaniss focused on psychodynamic listening with her listen/ reflect/intervene model (Cabaniss, Cherry, Douglas, & Schwartz, 2011). Residents were introduced to different types of listening and discussed ways to reflect on what they heard. ...
... Residents respond well to real-world case examples where psychodynamic principles or interventions can be demonstrated and where they can have the chance to appreciate that they are "thinking dynamically." Having a framework like "listen/reflect/intervene" in mind when talking with patients is organizing for residents who are unsure about what it means to interact dynamically (Cabaniss et al., 2011). Residents express the wish for sessions without faculty present to ask questions openly of their scholar. ...
Limited resources in psychodynamic education in psychiatry residency training led the American Academy of Psychodynamic Psychiatry and Psychoanalysis to create The Victor J. Teichner Award. This award funds a psychodynamic scholar to visit a psychiatry residency program to teach residents and faculty over a 2-3-day period. Anonymous online surveys were distributed before and after the visit to 88 residents from three residency programs. In comparing pre-visit and post-visit groups, residents rated themselves as significantly improved in psychodynamic psychotherapy regarding (1) their level of competence (p < 0.005), (2) their ability to listen (p < 0.009), and (3) their ability to make interventions (p < 0.002). In addition, residents in psychodynamically underserved programs expressed strong interest in learning both general and psychodynamic psychotherapy skills despite being in programs they view as predominantly biologically oriented. These findings suggest that brief, intensive programs to enhance psychodynamic teaching are useful in psychiatric education and can result in a significant increase in residents' sense of competence in psychodynamic psychotherapy.
... Austria has a wide range of established psychotherapy approaches, which can be classified into four orientations (psychodynamic, humanistic, systemic, and behavioral) (Heidegger, 2017). The main difference between the orientations resides in their understanding of the human psyche and their theories regarding the origin of mental disorders (DiTomasso et al., 2009;Pocock, 2015;Schlippe Von and Schweitzer, 2015;Cabaniss, 2016). Accordingly, different interventions are used in the treatment, and to some extent, the setting differs, e.g., the frequency of sessions and the duration of psychotherapy. ...
Studies report that psychotherapists overestimate their own performance (self-assessment bias). This study aimed to examine if the self-assessment bias in psychotherapists differs between therapeutic orientations and/or between social comparison groups. Psychotherapists gave subjective estimations of their professional performance (0–100 scale from poorest to best performance) compared to two social comparison groups (“all psychotherapists” vs. “psychotherapists with the same therapeutic approach”). They further rated the proportion of their patients recovering, improving, not changing, or deteriorating. In total, N = 229 Austrian psychotherapists (n = 39 psychodynamic, n = 121 humanistic, n = 48 systemic, n = 21 behavioral) participated in the online survey. Psychotherapists rated their own performance on average at M = 79.11 relative to “all psychotherapists” vs. at M = 77.76 relative to “psychotherapists with the same therapeutic approach” (p < 0.05). This was not significantly different between therapeutic orientations. A significant interaction between social comparison group and therapeutic orientation (p < 0.05) revealed a drop of self-assessement bias in social comparison group “same approach” vs. “all psychotherapists” in psychodynamic and humanistic therapists (p < 0.05). Psychotherapists overestimated the proportion of patients recovering (M = 44.76%), improving (M = 43.73%) and underestimated the proportion of patients not changing (M = 9.86%) and deteriorating (M = 1.64%), with no differences between orientations. The self-assessment bias did not differ between therapeutic orientations, but the social comparison group appears to be an important variable. A major drawback is that results have not been connected to patient-reported outcome or objectively rated performance parameters.
... In PDT, externalizing is often seen as an unconscious defense that is "a good indication of lack of awareness"(p.345) [43]. In the CBT, conversely, externalizing is often seen as a healthy way of coping with psychological disorder because it offers the patient to view the disorder "as separate from herself "(p.196) [15]. ...
Background
Research suggests that metaphors are integral to psychotherapeutic practice. We wanted to explore how 10 therapists reflect upon the use of metaphors in therapy, and how they react to some metaphors expressed by patients treated for of major depressive disorder (MDD).
Methods
Five therapists practicing psychodynamic therapy (PDT) and five practicing cognitive behavioral therapy (CBT) were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach.
Results
Our analysis resulted in two main themes: the therapeutic use of metaphors, and conflicting feelings towards metaphors used by depressed patients. Most therapists said that they do not actively listen for metaphors in therapy and many said that they seldom use metaphors deliberately. While PDT-therapists appeared more attentive to patient-generated metaphors, CBT-therapists seemed more focused on therapist-generated metaphors. Most therapists did not try to alter the patient-generated metaphors they evaluated as unhelpful or harmful. Some therapists expressed strong negative feelings towards some of the metaphors used by patients. PDT-therapists were the most critical towards the metaphor of tools and the metaphor of depression as an opponent. CBT-therapists were the most critical towards the metaphor of surface-and-depth.
Conclusions
These results remind us of the complexity of using metaphors in therapy, and can hopefully be an inspiration for therapists to reflect upon their own use of metaphors. Open therapeutic dialogue on the metaphor of tools, surface-depth and depression as an opponent may be necessary to avoid patient-therapist-conflicts.
Trial registration
Clinical Trial gov. Identifier: NCT03022071. Date of registration: 16/01/2017.
... The treatments followed the main steps well-described in the Psychodynamic Psychotherapy: A Clinical Manual [38], such as: (a) Establishing therapeutic alliance. (b) Listening to sounds (tone, volume, and timbre) and silence (the rhythm of sound stops and starts). ...
In Portugal, forest fires are responsible for disasters that tend to be repeated annually, leading to dramatic consequences, such as those that have occurred in 2017, with the destruction of hundreds of houses and the deaths of dozens of people. Firefighters who are exposed to these potentially traumatic events are considered a high-risk group for the development of stress-related disorders. The aim of this study was to monitor the progress of two firefighters with symptoms of post-traumatic stress disorder (PTSD) treated through dynamic psychotherapy (DP) and to assess the feasibility of implementing this intervention within fire departments. A female firefighter and a male firefighter, with similar sociodemographic characteristics and PTSD symptom severity, were selected to verify the treatment applicability for both genders. The symptomatology changes were assessed through a set of instruments (PHQ-15, PCL-5, BSI, DASS, and CALPAS-P) applied every three months over 15 months (including pre-treatment, treatment period, and post-treatment). DP seemed to be an effective treatment for PTSD symptoms, with patients showing a state of increasing improvement even after the end of treatment. The acceptability to firefighters, the treatment adherence, the therapeutic alliance, and the reduction in PTSD symptoms suggest feasibility for implementing this intervention inside the Portuguese fire departments.
... (Schedler, 2010, p. 98) La palabra psicodinámico significa 'mente en movimiento'. Por lo tanto, y desde esta perspectiva, serían ciertos elementos dinámicos que se encuentran en el inconsciente los que afectarían a los aspectos conscientes de una persona (Cabaniss et al., 2011): los «elementos dinámicos (en movimiento) en el inconsciente afectan los pensamientos, sentimientos y comportamientos conscientes» (p. 4). ...
El texto apela a la convergencia de dos disciplinas: filosofía y psicología. De la primera, toma la epistemología y de la segunda, la psicoterapia, confluyendo en una línea de investigación particular: la epistemología de la psicoterapia. Por tanto, el libro tiene por objetivo analizar los supuestos epistemológicos presentes en las corrientes psicoterapéuticas fundamentales (psicodinámica, cognitivo-conductual, humanista y sistémica), mediante un método filosófico fundamentado en la hermenéutica analógica. Además, el texto ofrece al lector un estado del arte de la psicoterapia y la epistemología.
... This factor perhaps reflects some combination of Gieselmann et al.'s (2019) hyperarousal and negative affect etiological mechanisms for nightmares and is somewhat consistent with Kelly & Yu's (2019) assertion that hyperarousal reflects weakened psychic structures that allow dysregulation. With regards to psychic structures, the Dysregulation facet appears somewhat akin to low ego strength, which is hypothesized to regulate mood, reality testing, and general executive functioning (Cabaniss, Cherry, Douglas, & Schwartz, 2011). ...
Previous research introduced the Nightmare Proneness Scale (NPS) as a measurement for nightmare proneness, the trait-like disposition to experience frequent nightmares. However, outside predicting nightmares, little is known about the structure of the scale or relationships of its facets with nightmares. The factor structure of the NPS and the scale’s statistical independence from psychological distress and negative affect were examined among a sample of 306 university students. The NPS predicted frequent distressing nightmares independent from psychological distress and negative affect. Three NPS facets were found representing general psychical dysregulation, depressiveness, and somatization. The NPS facet representing general dysregulation was the strongest predictor of nightmares and the only NPS facet to independently predict nightmares outside of distress and negative affect. The results, limitations, and directions for future research are noted.
... In psychodynamically informed patient assessments, the empirical data that descriptive psychiatry derives from epidemiologic studies, past and present psychiatric diagnosis, and psychobiological and family history complement the personal narratives. Likewise, state-ofthe-art psychodynamic formulations align with the biopsychosocial paradigm (Cabaniss et al., 2011). Biopsychosocial interventions allow for comprehensive psychiatric treatment approaches and multidimensional interventions. ...
The authors describe the practice of psychodynamic psychiatry in the Philippines. They review features of contemporary psychodynamic psychiatry, the state of psychodynamic psychiatry in training programs, and its integration in national professional societies. Despite psychodynamic psychiatry's wide acceptance in the professional community in the Philippines and neighboring Southeast Asian countries, delivery of care to over 110 million residents of the archipelago requires creativity given the small number of psychiatrists. The authors discuss how psychodynamic psychiatry impacts the national mental health scene and propose future directions involving forging international linkages.
... Of note, patients' defenses are often heterogeneouseven the high-functioning patient may use less adaptive strategies when under stress, and lower-functioning patients may have domains of function wherein they use more adaptive defenses. 6 ...
Patients with mood disorders often can benefit from psychotherapy, whether as a primary treatment for depression or as an adjunct to medications or other biological treatments. Today, therapeutic approaches such as cognitive–behavioral therapy and interpersonal therapy are commonly thought of as first-line evidence-based treatments of depression, yet there is also evidence that psychodynamic psychotherapy (PDT) and supportive psychotherapy (SPT) can be effective treatments of depression. Both PDT and SPT are commonly used in clinical practice, by a wide range of clinicians and in many different settings. This chapter describes the theoretical background of each of these therapies, therapeutic techniques, how they can be adapted for treatment of depression, and patient populations for which they may be indicated.
... Certains auteurs ont également tenté une manualisation relative de l'approche psychodynamique. Cabaniss (2016) dans sa forme plus générale ; Busch (2012) pour le traitement de la dépression ; et Bateman (2016) et Clarkin (2016) pour le traitement des troubles de la personnalité limite. Chacun de ces auteurs propose une approche balisée pour la pratique de la thérapie, en focalisant sur des enjeux psychodynamiques propres à certaines pathologies (p. ...
Objectifs Cet article décrit dans un premier temps les contributions du Dr Camille Laurin au développement des services psychiatriques à Albert-Prévost et plus spécifiquement le rôle qu’il a joué dans la promotion de la psychanalyse comme pensée ordonnatrice des soins thérapeutiques dans ce milieu. Dans un deuxième temps, la pratique de la psychothérapie psychodynamique est abordée à partir des enjeux contemporains liés à la médecine basée sur les données probantes, les neurosciences et le développement des technologies de la communication. Les modalités actuelles d’enseignement de l’approche psychodynamique à Albert-Prévost sont également introduites.
Méthode Dans la première partie, une recherche biographique a été effectuée. Dans la seconde, une revue de la littérature a été présentée.
Résultats Dr Camille Laurin a joué un rôle de premier plan dans le développement de la pensée psychanalytique à Albert-Prévost. Son héritage demeure bien vivant ainsi qu’en témoignent les divers stages et activités de formation offerts dans ce domaine au Centre de psychothérapie de cette institution. L’efficacité de la psychothérapie dynamique comme méthode de traitement est confirmée depuis maintenant plusieurs années. Les neurosciences et la psychanalyse bénéficient d’une ouverture à un dialogue interdisciplinaire. Le développement des technologies de la communication et de l’intelligence artificielle est appelé à modifier éventuellement la pratique de la psychothérapie.
Conclusion Les principes théoriques associés à la psychanalyse sont encore aujourd’hui enseignés à tous les résidents en psychiatrie de l’Université de Montréal. Dr Camille Laurin a joué un rôle essentiel dans le développement de cette approche à Albert-Prévost et plus généralement au Département de psychiatrie de l’Université de Montréal.
... Humanistic or "experiential" psychotherapies are based on humanistic psychology, focusing mainly on human development and individual needs, with an emphasis on positive growth and subjective meaning [24]. Psychodynamic approaches focus on revealing or interpreting unconscious conflicts, which are thought to cause mental disorders [25]. In contrast, systemic therapy focuses on the interactions of groups such as families, as well as their dynamics and patterns, rather than addressing people individually. ...
Background
The current situation around the COVID-19 pandemic and the measures necessary to fight it are creating challenges for psychotherapists, who usually treat patients face-to-face with personal contact. The pandemic is accelerating the use of remote psychotherapy (ie, psychotherapy provided via telephone or the internet). However, some psychotherapists have expressed reservations regarding remote psychotherapy. As psychotherapists are the individuals who determine the frequency of use of remote psychotherapy, the potential of enabling mental health care during the COVID-19 pandemic in line with the protective measures to fight COVID-19 can be realized only if psychotherapists are willing to use remote psychotherapy.
Objective
This study aimed to investigate the experiences of psychotherapists with remote psychotherapy in the first weeks of the COVID-19 lockdown in Austria (between March 24 and April 1, 2020).
Methods
Austrian psychotherapists were invited to take part in a web-based survey. The therapeutic orientations of the psychotherapists (behavioral, humanistic, psychodynamic, or systemic), their rating of the comparability of remote psychotherapy (web- or telephone-based) with face-to-face psychotherapy involving personal contact, and potential discrepancies between their actual experiences and previous expectations with remote psychotherapy were assessed. Data from 1162 psychotherapists practicing before and during the COVID-19 lockdown were analyzed.
ResultsPsychotherapy conducted via telephone or the internet was reported to not be totally comparable to psychotherapy with personal contact (P
... Some theorists (e.g. Cabaniss, 2011) have even suggested that trust is at the heart of the therapeutic relationship. Thus, client concealment of salient information and/or outright lies may be seen as threats to the integrity and mutative potential of the client-therapist relationship. ...
... The therapeutic alliance is one of the proposed tools in psychotherapy that allows for change. 12 The strength of the therapeutic alliance in telepsychiatry has been found to be equivalent to that of face-to-face visits. 13 Discussing the relationship between the doctor and patient is encouraged and should be addressed when making the transition to telepsychiatry sessions (Table 2). ...
Psychiatry is one of the first medical specialties to move to the practice of telehealth. Social distancing in the time of COVID-19 has prompted many face-to-face practices, including psychotherapy, to transition to virtual formats. Patients and physicians may have reservations about the change in approach and may have concerns about privacy and the security of protected health information. By utilizing telepsychiatry, patients and psychiatrists can have increased access to one another, bringing a host of benefits and challenges along with it. Addressing these concerns is an important part of telepsychiatry in psychotherapy practice. Here, we discuss practical solutions to challenges clinicians might encounter when moving a psychotherapy practice to telehealth, such as privacy issues, health information security, and developing/maintain a therapeutic bond.
... TF-CBT is a brief, resilience-building model for trauma-impacted children or adolescents and their parents and caregivers that adapts the tenets of CBT for healing from trauma. 8 The components are presented in Table 2. 9 One of the main tasks of TF-CBT is collecting the trauma narrative. Over the course of several sessions, the child is encouraged to discuss in detail the events surrounding the traumatic event. ...
Sexual assault and abuse can result in severe physical and emotional trauma to the victim. Deploying targeted psychotherapeutic treatment that is individualized for the survivor is important to achieving optimal patient outcomes. There are several valid and evidence-based treatments available for posttraumatic stress disorder (PTSD) and interpersonal difficulties that can result from sexual abuse and assault. In this article, the authors discuss psychodynamic psychotherapy, trauma-focused cognitive behavioral therapy (TF-CBT), and eye movement desensitization and reprocessing therapy (EMDR) for the treatment of patients following sexual assault and abuse. The authors also provide practice points on common issues in the management of the treatment of sexual assault survivors, including transference, countertransference, and avoiding retraumatization. Composite case vignettes are used to illustrate treatment techniques.
... Explanations and examples of immature, maladaptive defenses are summarized in Table 1. 1 We find many of our usual adaptive coping skills and diversions no longer safe due to social distancing requirements: spending quality time with loved ones, going to the gym, and attending a concert. Some outlets that were formerly conceptualized as maladaptive, such as spending hours in front of the computer and days on end at home, are now required to maintain one's livelihood. ...
... Humanistic or "experiential" psychotherapies are based on humanistic psychology, focusing mainly on human development and individual needs, with an emphasis on positive growth and subjective meaning [24]. Psychodynamic approaches focus on revealing or interpreting unconscious conflicts, which are thought to cause mental disorders [25]. In contrast, systemic therapy focuses on the interactions of groups such as families, as well as their dynamics and patterns, rather than addressing people individually. ...
BACKGROUND
The current situation around the novel coronavirus disease (COVID-19) and the measures necessary to fight it are a challenge for psychotherapists, who usually treat face-to-face in personal contact. This situation accelerates the use of remote psychotherapy, i.e. psychotherapy provided via telephone or internet. However, some reservations against remote psychotherapy have been shown in psychotherapists. As psychotherapists are the individuals who determine the frequency of use of remote psychotherapy, the potential of enabling mental health care during COVID-19 in line with the protective measures to fight COVID-19 can be realized only if psychotherapists are willing to utilize remote psychotherapy.
OBJECTIVE
The aim of this study was to investigate experiences with remote psychotherapy in the first weeks of the COVID-19 lockdown in Austria (between March 24th and April 1st, 2020)
METHODS
Austrian psychotherapists were invited to take part in an online survey. The therapeutic orientation (behavioral, humanistic, psychodynamic, systemic), the rating regarding comparability of remote psychotherapy (internet, telephone) with face-to-face psychotherapy in personal contact, as well as a potential discrepancy between actual experiences and previous expectations with remote psychotherapy were assessed. Data of 1,162 psychotherapists practicing before as well as in the COVID-19 lockdown were analyzed.
RESULTS
Psychotherapy conducted via telephone or internet was reported not to be totally comparable to psychotherapy in personal contact (P < .001). Lowest comparability for psychotherapy via telephone was reported by behavioral psychotherapists, while the highest ratings were reported by psychodynamic and humanistic therapists (P = .001). Irrespective of therapeutic orientation, a more positive experience with remote therapy (internet as well as telephone) compared to previous expectations was observed (P < .001). However, psychodynamic therapists reported a more positive actual experiences for psychotherapy via telephone than expected previously, compared to behavioral and systemic therapists (P = .001). For therapy conducted via internet the therapeutic orientation neither affected the rating regarding comparability to psychotherapy in personal contact, nor the rating regarding the discrepancy in experiences with expectations. Psychotherapy via internet was rated to be more comparable to psychotherapy in personal contact than psychotherapy via telephone (P < .001). The more positive actual experiences than previous expectations with remote psychotherapy were more pronounced for psychotherapy via internet as compared to psychotherapy via telephone (P < .001); however, this discrepancy of expectations vs. experiences between psychotherapy via telephone and internet did not reach significance in psychodynamic therapists.
CONCLUSIONS
Psychotherapists experienced remote psychotherapy (i.e., psychotherapy via internet) better than expected, but not totally comparable to face-to-face psychotherapy in personal contact. Especially behavioral therapists were found to rate psychotherapy via telephone less favorable than therapist with other theoretical backgrounds.
... As noted above, a foundational theory that may be the bedrock of psychoanalysis is that forbidden impulses, urges and wishes are held in abeyance in the unconscious due to defenses (Brenner 1974;McWilliams 2011;Cabaniss 2016). These defenses classically include repression most prominently but also include projection, displacement, reaction formation, isolation of affect and sublimation as well as more primitive defenses such as splitting, projective identification and dissociation. ...
Psychodynamic psychotherapy (PDT) and emotion-focused therapy (EFT) have much in common and much to offer one another. Yet, their differing theoretical foundations create challenges when attempting to integrate the two. PDT is founded on concepts such as the dynamic unconscious, defenses, a developmental perspective and recurrent patterns including transference that are not included in EFT theory. By contrast, EFT is founded on basic affective science rather than clinical observations, a focus on experiencing affect fully rather than simply overcoming defenses and an emphasis on gestalt methods such as 2-chair work rather than working mainly within the experiential field of the therapeutic dyad. If one were to aim for a more balanced integration key psychodynamic concepts would need to be reconceptualized in more empirically-tractable terms and concepts. The central thesis of this paper is that psychodynamic concepts could have broader and more generalized application and potential for integration with other modalities if they were updated in light of advances in affective science and neuroscience. Specific core concepts addressed in this way include unconscious processes, development, conflicts, defenses and the mechanisms of therapeutic change. These conceptual refinements highlight the importance of observable behavior, emotional experiencing and learning in defining the nature of clinical problems and their treatment.
... An example of such an endeavour can be identified in the visual imageries displayed by Freud's archaeological exhibits, his paintings and wall hangings, antiquities, books and certificates that were in his clinic (Burke, 2007). These furnishings of the room, the layout and the decorations, and the antiques immediately convey a set of expectations about what will happen in the room (Cabaniss, Cherry, Douglas, & Schwartz, 2011). Later, Carl Rogers, in his person-centred work, changed the context and talked about the environment being conducive to growth in the client (Rogers, 1951). ...
The influence of the physical environment on the counselling process is an inevitable part of a counselling session. However, there is little insight in Indian research into the desirable elements of the physical environment of the counselling room that helps facilitate a counselling session. Interviews were conducted with 10 professional counsellors in India. Thematic analysis of the data brought out various Basic and Organising themes under the following three Global themes: (a) Elements of the physical framework; (b) Counsellor's perspectives about the physical framework in counselling; and (c) Motivation to build a framework. The findings show how counsellors can systematise the physical framework to help construct the counselling session effectively.
... The knitting together of pathways to victimization is important from a basic science standpoint, but it also has the potential to inform translational knowledge. Poor impulse regulation, for instance, is amenable to intervention (Piquero et al. 2010;Piquero et al. 2016) and may be especially responsive to certain psycho-therapies (Cabaniss et al. 2016;Preuss et al. 2017). Indeed, Pandey et al. (2018) recently meta-analyzed 17 cluster randomized trials and roughly 32 randomized clinical trials (over 23,000 subjects in total) in order to evaluate interventions intended to improve self-control skills in children and adolescents. ...
Objectives: Examine the extent to which cognitive/psychological characteristics predict later polyvictimization. We employ a twin-based design that allows us to test the social neurocriminology hypothesis that environmental factors influence brain-based characteristics and influence behaviors like victimization.
Methods: Using data from the Environmental Risk Longitudinal Twin Study (N = 1986), we capitalize on the natural experiment embedded in a discordant-twin design that allows for the adjustment of family environments and genetic factors.
Results: The findings indicate that self-control, as well as symptoms of conduct disorder and anxiety, are related to polyvictimization even after adjusting for family environments and partially adjusting for genetic influences. After fully adjusting for genetic factors, only self-control was a statistically significant predictor of polyvictimization.
Conclusion: The findings suggest polyvictimization is influenced by cognitive/psychological characteristics that individuals carry with them across contexts. Policies aimed at reducing victimization risks should consider interventions that address cognitive functioning and mental health.
... Pychodynamic (or psychoanalytic) psychotherapy is the form of clinical practice based on the theoretical body of psychoanalysis ( Cabaniss et al. 2011, Chapter 2; Summers and Barber 2010, p. 11). There is mixed evidence with regard to the efficacy of psychodynamic therapy. ...
A relevant issue in the philosophy of science is the demarcation problem: how to distinguish science from nonscience, and, more specifically, science from pseudoscience. Sometimes, the demarcation problem is debated from a very general perspective, proposing demarcation criteria to separate science from pseudoscience, but without discussing any specific field in detail. This article aims to focus the demarcation problem on particular disciplines or theories. After considering a set of demarcation criteria, four pseudosciences are examined: psychoanalysis, speculative evolutionary psychology, universal grammar, and string theory. It is concluded that these theoretical frameworks do not meet the requirements to be considered genuinely scientific.
... 16 Some psychotherapeutic modalities for psychiatric conditions are associated with worsening symptoms early in treatment (e.g., regression in psychodynamic therapy, worsening posttraumatic stress disorder symptoms in prolonged exposure or trauma-focused cognitive behavioral therapy). 17 If employing these potentially activating modalities or others associated with discomfort, it is important to remain mindful that substance use patterns can change during treatment. Substance use can impede the progress of psychotherapy; thus, at times, it might be prudent to refer the patient to an intensive treatment program for addiction prior to embarking upon psychotherapy. ...
Substance use disorders are widespread and cause significant dysfunction. Substance use disorders often co-occur with other psychiatric disorders. Because of this overlap, clinicians commonly encounter patients at risk for substance abuse disorders. This article reviews strategies to aid the practicing clinician in the screening, assessment, intervention, and referral of their parents at risk for substance use disorders.
A psychodynamic formulation is like a map—it guides every aspect of treatment. Having a working psychodynamic formulation enables us to make treatment recommendations and set goals; understand what patients need developmentally; develop therapeutic strategies and predict how patients will react in treatment; construct meaningful interventions; and help patients create cohesive life narratives. Having a working psychodynamic formulation means having continuously evolving ideas about the conscious and unconscious thoughts and feelings that affect the patients’ ways of thinking, feeling, and behaving. Initially the therapist shares their preliminary formulation with the patient to make a treatment recommendation and to collaboratively set early goals. The therapist's forms a therapeutic strategy, where they will listen to the patient. As the treatment unfolds, patient and the therapist deepen this formulation, and the therapist uses the evolving formulation to set goals, develop therapeutic strategies, make interventions, and foster patient's understanding of life.
Psychodynamic formulations can help us to optimize psychopharmacologic treatment. In this context, the most helpful psychodynamic formulations target issues related to symptoms, medications, compliance and side effects. Patients who come for medication visits, however, are just as likely to discuss emotionally meaningful topics as are patients in psychotherapy. A psychodynamic formulation can be a helpful guide even when the treatment is envisioned as primarily pharmacologic. The way in which patients present for the initial consultation will guide the approach to gathering information for the targeted psychodynamic formulation. The psychodynamic formulation in a psychopharmacologic treatment targets the problems and patterns that affect the patient's feelings, attitudes, and behaviors toward medication. Patients who are reluctant to depend on others may feel that relying on a pill, or on the doctor whom they need to see for the prescription, is a weakness or blow to their sense of independence or self‐reliance.
An organizing idea about development, called ego psychology, suggests that adult problems and patterns can be LINKED to unconscious conflicts and defenses. The idea that problems and patterns can be linked to unconscious conflict was originally conceptualized by Freud. The resulting thought, feeling, or behavior is thus a compromise. People often come to therapists because they feel stuck. They might feel stuck in a relationship, in a job, or in a decision. Thinking about the mind in terms of conflict and defense generally presumes that people have capacities that they defensively inhibit. A formulation using ego psychology hypothesizes that problems and patterns are linked to unconscious conflicts and defenses. A good analogy is the item in a dark bedroom that looks like an intruder but is revealed to be a hat on a chair when the light is turned on— making things conscious helps us to view them in a more realistic way.
The patient's response helps to shape and hone the therapist's ideas. It reviews some principles for considering how and when to engage in collaborative formulating with our patients. Short segments of formulation that are directly related to what is uppermost in the patient's mind are most likely to have a therapeutic effect. In all health fields, explaining the rationale for the recommended treatment is a crucial part of informed consent. For many patients, being able to construct a narrative of how they came to be the way they are can be very therapeutic. By offering a developmental perspective, sharing our formulations can also help patients who face difficult insights about themselves in therapy. During the ending phase of therapy, it is often helpful to give patients explanatory summaries they can take with them, reminding them of what they have learned.
The way we think is reflected in almost everything that we do, including problem‐solving, organizing thoughts, remembering things, and focusing our attention. Some people have strengths in one area of cognitive function and difficulties in another. Describing cognitive function is essential to the process of psychodynamic formulation for several reasons. This chapter describes cognitive function using the following variables: basic cognitive abilities, higher functions, and reflective functions. Basic cognitive abilities are the built‐in intellectual/cognitive capacities with which a person is innately equipped and include intelligence, memory, attention, perception, speech and language, and the ability to organize thought. Higher cognitive functions include emotional regulation, impulse control, judgment, stimulus regulation, decision‐making and problem‐solving. Reflective or metacognitive functions enable us to observe our own thoughts and feelings, understand and think about the mental states of others, and discriminate between perceptions that are real and those that are not.
Treatment specificity and adherence to treatment manuals represent essential components of the medical model in psychotherapy. The model assumes that psychotherapists who work with the same type of clients and who identify with the same theoretical approach work very similarly. This study illustrates the shortcomings of that assumption and explores how therapists’ individuality forms and shapes their unique approaches that resonate with their own personalities, inclinations, and worldviews. Semi-structured interviews with eight Gestalt therapists working with clients who experienced medically unexplained physical symptoms were analysed using the grounded theory method. Considerable differences were found among the therapists within four domains of the personal therapeutic approach, namely Case Conceptualization, Therapeutic Task, Therapist’s Position, and Alternative Strategy. However, regardless of the differences, all the therapists endeavoured, either implicitly or explicitly, to convey to the clients what they considered to be healthy functioning. There is considerable diversity in the way therapists work even when they subscribe to the same psychotherapeutic approach and work with the same type of clients. The exploration of psychotherapists’ usual strategies, as well as the alternative strategies they use when their usual strategies do not work, appears helpful for capturing their personal therapeutic approaches.
The capacity for self-transcendence through the suspension of belief/judgment involves neutralizing, as much as humanly possible, our biased, judgmental Self with which we ordinarily identify in our everyday lives. It further involves identifying with a compassionately witnessing Self, a caringly participant-observer Self. Though never totally, we are then better poised to understand the basic essential, unadulterated meanings of our interpersonal world.
The capacity for empathy emerges from the original ability to echo others—our primary capacity for identificatory resonance. Empathy may then be defined as the ability to identify with the Other for the purpose of grasping her or his subjective experience. Mature empathy requires nurturance and cultivation. Its pervasive presence is a sign of mental health. However, empathy is achieved in degrees and may be selectively exercised in different social contexts. When the ability to enter imaginatively and accurately into the subjective experience of the Other is reciprocated between two partners over time it results in strengthening their loving bond. Empathy requires balancing with compassionate, reflective distancing.
The bodily self naturally desires truthful (accurate) emotional and relational meanings to live by. Meanings refer to anything or anyone out there in the lifeworld. Meanings are not only affect-and-value laden; they are also action meanings. Meanings are co-created and co-actualized, for they are always, already having been made by others. Truths, which are always perspectival, and thus partial and never absolute, are meanings that are accurate manifestations of social reality. Becoming mature means refining the accuracy or truthfulness of our (shared) lifeworld meanings (or co-meanings) – what our selves and others that we care about mean to us. Ultimately, truthful selving, ethical selving, and aesthetic selving unfold together as a unified whole.
Background
The quality of the physician-patient relationship is associated with improved healthcare outcomes and patients’ complaints due to dissatisfaction. Factors that influence the quality of the physician-patient relationship include verbal communication, nonverbal communication, and clinical empathy. These factors have been studied from diverse theoretical approaches hindering their integration into a theoretical framework applicable in clinical practice and accessible for lay clinicians.
Objective
The aim of this paper is to put forward a psychodynamic framework that includes the factors associated with a better quality of the physician-patient relationship and is applicable in clinical practice and accessible for lay clinicians.
Theoretical discussion
Basic concepts necessary to comprehend transference and countertransference phenomena were outlined. Then, based on the concepts of transference and countertransference, a psychodynamic framework to understand and manage the physician-patient relationship was put forward.
Conclusion
This is the first paper that presents a psychodynamic framework applicable in clinical practice and accessible to lay clinicians for understanding and managing the physician-patient relationship. Additionally, this work could serve as introductory material to Balint groups.
The medium of film offers unique opportunities to explore sports fans’ individual and collective imaginative investments in sport. Through the potential for deviation from realist form and aesthetic in both fiction and documentary, film can dramatise and visualise fans’ often complex and ambivalent relationships with sport teams and individual sport stars. Drawing on concepts and approaches from Freudian and object relations psychoanalysis, this chapter explores this theme, primarily through analysis of Ken Loach’s 2009 film Looking for Eric. The film offers a utopian vision of a fan who finds in his fantasy version of former Manchester United star Eric Cantona a supreme individual talent who also provides a reminder of football’s moral lesson of collective mutual dependence and solidarity at a time of personal despair. Rather than seeing its central character as delusional it depicts his emotional investment in the idealized Cantona as a creative ‘illusionment’ through which he finds a solution to his difficulties by placing trust in his co-workers as teammates.
Introduction:
Psychodynamic psychiatry forms the fundamental theoretical frame of reference for psychodynamic psychotherapy and related therapies using psychodynamic concepts. Over time, it faced questions about its empiricism, evidence base, cost-effectiveness, and fitness to the medical role. Although recent studies have reaffirmed its effectivity in mainstream medicine, its clinical practice in the local setting raises questions about the Filipino psychiatrists' systematic understanding and orientation to it, and signals a call for action.
Methodology:
Attendees in the UP Philippine General Hospital - Department of Psychiatry and Behavioral Medicine (UP PGH-DPBM), 13th Post-Graduate Course on Psychodynamic Psychotherapy, participated in an informal survey to generate hypotheses on the knowledge, perceptions, and attitudes of Filipino mental health professionals regarding psychodynamic psychotherapy. One hundred eighty-two (182) respondents answered the survey and results were analyzed using descriptive statistics.
Results and discussion:
Among the respondents, about 30% practiced psychodynamic psychotherapy and cognitive behavioral therapy (CBT) in equal parts, 15% practiced mostly psychodynamic psychotherapy and 15% practiced mostly CBT, while the rest were either unsure or practiced other forms of psychotherapy. Most agreed that psychodynamic psychotherapy required scientific rigor and remained applicable, but were divided on treatment frame and boundary setting, approach selection, and specific concepts and techniques. In terms of perceptions and attitudes toward psychodynamic psychotherapy, most respondents displayed positive attitudes and interest in the intervention, but did not highly regard their own competence. These findings steer psychodynamic psychotherapy research toward the systematic review of the competence of trainees and practitioners, the standardization of its education and training, and its applicability in a cultural context of limited resources.
Well‐being has become a prominent theme for higher education in North America. This paper explores how we might best understand well‐being in higher education, given the premium it puts on rationality and critical thinking, in light of insights from psychodynamic theory. The author presents a brief history of the concept of well‐being in psychology and higher education, how the unconscious came to be barred from current discourse, and how it might re‐establish its place if reframed in terms of the preconscious and sublimation. The author then discusses key concepts from transformative education theory and mindfulness practice, which have had explicit presences in higher education theory and practice, for the helpful roles they might play in bringing this about, since at their borders, the unconscious makes its presence known. Finally, the author poses a way that rationality and depth psychology may co‐exist in higher education and bring about fruitful educational results.
The quality of the physician-patient relationship has been empirically associated with improved healthcare outcomes and patients’ complaints due to dissatisfaction. Factors that influence the quality of the physician-patient relationship include verbal communication, nonverbal communication, and clinical empathy. These factors have been studied from diverse theoretical approaches, which have made it difficult to integrate them into a unified theoretical framework. Psychodynamic psychology has long studied the aforementioned factors through the concepts of transference and countertransference. Therefore, it could provide clinicians a unified theoretical framework for understanding and managing the physician-patient relationship. The objective of this theoretical article is to present a coherent psychodynamic model of the physician-patient relationship based on these concepts. Theoretically, applying the concepts and techniques outlined in this paper would improve the quality of the physician-patient relationship and thus, improve healthcare outcomes.
review our work on the predictive power of the Adult Attachment Interview (AAI) [developed by] Mary Main / the studies bear on 2 related areas: (1) the effect of the parent's representation of interpersonal relationships on the child's attachment and (2) the intergenerational effects of maltreatment and abuse on attachment-related representational systems / aim is . . . to identify aspects of normal developmental process that might be of value in our understanding of clinical problems and to inspire effective modes of intervention / to illustrate the clinical relevance of this model, . . . consider borderline personality disorder from the point of view of attachment theory (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Core psychoanalytic constructs may be impossible to study directly using neuroscience and imaging methodologies. Nevertheless, experimental paradigms have been developed and are being applied that are at least relevant to understanding the neural bases of certain core theoretical constructs within psychoanalysis. These paradigms have demonstrated the likely contributions of: (1) the nucleus accumbens and related limbic circuitry in assigning valence within the pleasure/unpleasure continuum of affective experience; (2) the reticular formation, thalamus, amygdala, and cortex within arousal circuits in assigning personal salience to those affective experiences; (3) frontostriatal systems in subserving top-down processing in the CNS, which in turn contributes to numerous important psychological functions, including the control of drives and the construction of experience according to preestablished conceptual schemas—processes that likely underlie cognitive distortions, projection, and transference phenomena; and (4) multiple memory systems, particularly the procedural learning systems based within the dorsal striatum and declarative learning systems in the mesial temporal lobe, that likely contribute to memories within the domain of the descriptive unconscious, and the interactions across affective and cognitive memory systems, that might contribute to memory formations within the dynamic unconscious. q 2005 Association for Research in Nervous and Mental Disease. Published by Elsevier B.V. All rights reserved.
The strength of psychoanalysis has always been its understanding of affect and motivation. Contemporary developments in cognitive neuroscience offer possibilities of integrating sophisticated, experimentally informed models of thought and memory with an understanding of dynamically and clinically meaningful processes. Aspects of contemporary theory and research in cognitive neuroscience are integrated with psychoanalytic theory and technique, particularly theories of conflict and compromise. After a description of evolving models of the mind in cognitive neuroscience, several issues relevant to psychoanalytic theory and practice are addressed. These include the nature of representations, the interaction of cognition and affect, and the mechanisms by which the mind unconsciously forges compromise solutions that best fit multiple cognitive and affective-motivational constraints.